Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study

doi:10.1016/j.ijnurstu.2009.12.011

International Journal of Nursing Studies

Volume 47, Issue 7, July 2010, Pages 888-895

https://doi.org/10.1016/j.ijnurstu.2009.12.011 Get rights and content

Abstract

Background

Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care.

Aims

The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care.

Methods

A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed.

Results

There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood.

Conclusion

Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.

Section snippets

Methods

We explored HF self-care in a cross-sectional, comparative mixed methods study conducted in 2008 in Melbourne, Australia. In-depth interviews were used to elicit self-care behaviors and to explore the barriers and facilitators of self-care. The qualitative analysis was considered primary in this study (QUAL quan). After the interview data were analyzed, the results were verified in the quantitative data obtained from the same sample and at the same time.

Results

Although a purposive sampling strategy was used to obtain an equal number of men and women, only 8 women and 19 men completed the study. We enrolled 40 persons and 27 completed the qualitative interview and all the quantitative surveys. Two additional participants completed all the surveys but not the interview, so they were not included here. Eleven who agreed to participate failed to do so because of ill health (n = 6), an inability to contact them after they signed the consent (n = 2), or

Discussion

The finding that men and women are comparable in the extent to which they adhere to treatment is not new; several others have found a similar result (Heo et al., 2008, Holst et al., 2007, Lee et al., 2009). What is new is identification of gender-specific barriers and facilitators that greatly influenced self-care. In this sample, women were more uncertain about their symptoms and tentative about taking action without guidance from a provider while the men felt more confident in their self-care

Conclusion

The results of this study support our prior conclusion that gender-specific differences in specific self-care behaviors are minimal. It does not appear that gender differences in self-care are responsible for the gender differences in outcomes known to exist. However, there are distinct gender differences in the decisions made in interpreting and responding to symptoms. These decisions are influenced by factors that are unique to men and women, including self-care confidence, the importance of

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A patient-level randomized parallel-group superiority trial with 32 primary care practice teams, 11 care managers and 495 patients was conducted. The intervention was delivered as add-on to an already implemented disease management program and embedded in a network of primary care practices. Hierarchical linear modeling was used to analyze impacts of the care management approach on HRQoL.
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To identify the gender differences in self-care maintenance and its associations among chronic heart failure patients using the Information-Motivation-Behavioral Skills model.
Two hundred and ten patients (54.0% female) with chronic heart failure participated in this cross-sectional study. Self-care, knowledge of heart failure, social support and illness perception were measured using the Self-Care of Heart Failure Index, the questionnaire of heart failure knowledge, the Perceived Social Support Scale, and the Revised Illness Perception Questionnaire, respectively.
Mean scores for self-care maintenance were 51.4 ± 14.8 in men and 55.6 ± 14.1 in women (t = −2.066, P < 0.05). Associated factors of self-care maintenance were social support and self-care confidence in men and the knowledge of heart failure, self-care management and self-care confidence in women. The relationship between social support and self-care maintenance was meditated by self-care confidence in men, whereas the relationship between knowledge of heart failure and self-care maintenance was meditated by self-care management and self-care confidence in women.
Self-care maintenance were inadequate in both genders with chronic heart failure. Interventions for enhancing social support and self-care confidence in men patients, and strengthening knowledge of heart failure, self-care management and self-care confidence in women patients, may facilitate self-care maintenance.
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The importance of outpatient monitoring and self-care has become increasingly evident over the past decade. Large amounts of research and resources have been allocated to facilitating more appropriate, timely, and comprehensive care of adults living with heart failure. Furthermore, education of patients regarding the importance of self-care continues to be a major area of interest. The optimal care of heart failure patients in the present era is very complex, which requires a multidisciplinary approach that leverages multiple modalities. There are past and ongoing learning from adults with heart failure that can be applied to pediatric patients. However, novel approaches to infants, children, adolescents, and their families will need to be developed that take into account the unique needs of the pediatric heart failure population. This is an exciting time in the outpatient care of children and adults given the almost daily development of new technologies that can facilitate bidirectional communication between patients/families and providers providing both subjective and objective data that can enhance care delivery well beyond our current practice.

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Gender-specific barriers and facilitators to heart failure self-care: A mixed methods study

Abstract

Background

Aims

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Conclusion

J. Chronic Dis.

Heart Lung

J. Cardiac Failure

J. Am. Coll. Cardiol.

Int. J. Nurs. Stud.

Int. J. Nurs. Stud.

Patient Educ. Counsel.

J. Cardiac Failure

Heart Lung: J. Acute Crit. Care

Diagnostic and Statistical Manual of Mental Disorders. Primary Care Version (DSM-IV-PC)

Within-case and across-case approaches to qualitative data analysis

Qual. Health Res.

Self-efficacy mechanism in human agency

Am. Psychol.

An exploratory study of developmental growth in adults with heart failure

J. Holistic Nurs.

Descriptions of barriers to self-care by persons with comorbid chronic diseases

Ann. Fam. Med.

Exploring self-efficacy as a predictor of disease management

Health Educ. Behav.

Analyzing Data in Mixed Methods Research Designing and Conducting Mixed Methods Research

BSI. Brief Symptom Inventory. Administration, Scoring, and Procedure Manual

A typology of heart failure self-care management in non-elders

Eur. J. Cardiovasc. Nurs.

Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research

Med. Care

British community norms for the brief symptom inventory

Br. J. Clin. Psychol.

Self-care of persons with heart failure: does experience make a difference?

Clin. Excellence Nurse Practitioners

Nurse evaluation of patients in a new multidisciplinary Heart Failure Unit in Spain

Eur. J. Cardiovasc. Nurs.